Lumbar juxta-facet cyst after trauma

Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases

OBJECT

The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach.

METHODS

All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times.

RESULTS

There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m2. Sixty-nine percent (9 of 13) of the cysts were at L4–5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series.

CONCLUSIONS

The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.

Foot drop of sudden onset caused by acute hematoma in the lumbar ligamentum flavum: a case report and review of the literature

STUDY DESIGN

A case report.

OBJECTIVE

To describe an unusual case of acute hematoma in the lumbar ligamentum flavum causing foot drop.

SUMMARY OF BACKGROUND DATA

There have been several reports of hematoma in the lumbar ligamentum flavum causing compression of the cauda equina and/or nerve root. However, the majority of these cases were chronic hematomas, based on clinical history and histologic findings.

METHODS

A 64-year-old man presented with right foot drop of sudden onset and severe sciatica. Magnetic resonance imaging (MRI) on the 10th day after the onset of symptoms revealed spinal stenosis at L4/5 caused by a posterior mass that was isointense on T1-weighted images and hyperintense on T2-weighted images, but was hyperintense on T1-weighted images and hypointense on T2-weighted images 5 days later. Because of these neurologic findings, surgical exploration and excision of the intraspinal mass were performed on the 18th day after onset.

RESULTS

Surgical treatment was uneventful, and the severe sciatica improved immediately after surgical treatment. Histologic examination revealed recent extravasation of blood in the degenerated ligamentum flavum. These findings were supported by the 2 consecutive preoperative MRI examinations. At 1 year after surgery, manual muscle testing of the tibialis anterior on the affected side had recovered to grade 4.

CONCLUSION

Consecutive MRI examinations performed 5 days apart in the early stage after the onset of symptoms clearly demonstrated intensity change, indicating acute hematoma of ligamentum flavum as a cause of foot drop of sudden onset.